Investigation of thyroid nodules: A practical algorithm and review of guidelines

Song, Jin Soo; Dmytriw, Adam A; Yu, Eugene; Forghani, Reza; Rotstein, Lorne; Goldstein, David P.; Poon, Colin S.

doi:10.1002/hed.25160

Cited by 8 publications

(6 citation statements)

References 50 publications

(231 reference statements)

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“…In some cases, an approach that combines different ancillary techniques has proved to offer greater diagnostic accuracy than a single technique alone [ 18 , 36 – 39 ]. As reported in previous studies [ 15 – 17 , 40 ], our data confirmed the role of conventional ultrasound as the basis for the assessment, owing to its advantages in terms of cost and time. However, the need for a scoring system that performs better than the separate evaluation of single items is increasingly evident.…”

Section: Discussionsupporting

confidence: 90%

“…However, the need for a scoring system that performs better than the separate evaluation of single items is increasingly evident. Many different systems have been created in order to meet this need [ 16 , 17 ]; hypo-echogenicity, irregular margins, and the presence of microcalcifications are acknowledged to be risk factors for malignancy, while the role of intra-nodular vascularization is still debated [ 3 , 22 , 27 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

et al. 2018

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BackgroundIn thyroid nodules with indeterminate cytology, further clinical assessment aimed at ruling out malignancy is often mandatory. Ancillary imaging techniques and genetic mutation analysis can improve the risk stratification of such lesions, thereby facilitating the clinician’s decision to undertaken surgery or simple follow-up. The aim of this study was to evaluate the diagnostic performance of shear-wave elastography (SW), strain elastography (ELX 2/1), conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), and BRAF V600E mutation analysis in the aforementioned lesions.Material/MethodsWe enrolled 81 patients, each with 1 indeterminate-cytology thyroid nodule. Thyroid function, thyroperoxidase antibodies and calcitonin were known in each case. SW, ELX 2/1, US, CEUS, and BRAF mutation analysis were subsequently performed, followed by a second FNAB. If the lesion was not downgraded to benign, surgery was recommended and histological reports collected.ResultsThere were 28 nodules (34%) that proved benign on the second FNAB; 38 nodules (47%) underwent surgery (17 benign, 21 malignant), and 15 nodules (19%) refused surgery. The only techniques related to histological outcome were US (AUC=0,766), ELX 2/1 (AUC=0.701), and BRAF analysis (AUC=0.762). ELX 2/1 and SW reports were not correlated with each other (P=0.45). A scoring system taking into account all the variables considered performed better than the single variables alone (AUC=0.831).ConclusionsIn indeterminate-cytology thyroid lesions, repeating FNAB can avoid unnecessary surgery. ELX 2/1 seems to perform better than SW in distinguishing malignancy; these techniques could, however, be complementary in describing such lesions. A multiparametric approach appears the most accurate in predicting nodule histology.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

et al. 2018

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“…Fine needle aspiration (FNA) of the thyroid plays a vital role for the evaluation of thyroid nodules since the 1970s to distinguish between benign and malignant disease [4]. FNA has been established as a cost-effectiveness diagnostic tool to select the appropriated patients for thyroid surgery [5].…”

Section: Introductionmentioning

confidence: 99%

Incidence and malignancy rates classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) – An 8-year tertiary center experience in Thailand

Thewjitcharoen

Butadej

Nakasatien

et al. 2019

Journal of Clinical & Translational Endocrinology

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Incidence and Malignancy Rates Classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) – An 8-year Tertiary Center experience in Thailand. Background Fine-needle aspiration (FNA) of the thyroid is considered the best diagnostic tool for preoperative evaluation of thyroid nodules. The introduction of T he B ethesda S ystem for R eporting T hyroid C ytopathology (TBSRTC) in 2010 provided the opportunity to establish worldwide standard for reporting and terminology guidelines for diagnostic categories. It is recommended that every institution evaluates the risk of malignancy (ROM) in each category for quality improvement process. Aim To assess the effectiveness of TBSRTC method at our institution using cyto-histological correlation. Method A retrospective 8-year (2010–2017) audit of thyroid FNA done by thyroid specialists at Theptarin hospital. The FNA results were classified according to TBSRTC. Histopathology reports for operated cases were used to correlate cytology and final histopathology. Results A total of 2735 thyroid FNA from 2115 patients (mean age 45.7 ± 13.1 years, female 89.8%) were examined. The rates of non-diagnostic, benign, atypia of undetermined significance (AUS), follicular neoplasm, suspected for malignancy, and malignant cases were 21.1%, 66.6%, 4.7%, 2.4%, 1.8%, and 3.3% respectively. There were 188 patients (9%) who underwent surgical resection with available histopathology. Malignancy rates in operated thyroid nodules were 20.0%, 4.2%, 9.4%, 23.5%, 57.1%, and 90.3% for categories 1 to 6, respectively. The sensitivity, specificity, negative predictive value, and positive predictive value were 96.6%, 88.5%, 95.8%, and 90.3, respectively. Conclusions Preoperative diagnosis of thyroid nodules using TBSRTC in our hospital was comparable with other studies. The uniform diagnostic criteria of the Bethesda System help avoid misinterpretation while sharing local experience with international benchmarks.

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“…Thyroid cancer (TC) instead, despite being the most common endocrine tumor, represents less than 1% of all newly diagnosed malignancies [2]. From a histological point of view, follicular cells within the thyroid gland are responsible for tumorigenesis and generate three main types of differentiated thyroid cancer (DTC): papillary (PTC), follicular (FTC) and mixed cell variants, which account for approximately 95% of all thyroid carcinoma, all of which are commonly well differentiated therefore these tumors are iodine avid and diagnosed/treated with I-123 or I-131, although they also include many subtypes that have different outcomes in terms of response to therapy and prognosis [5]. Undifferentiated and anaplastic tumors are not always iodine avid due to tumor dedifferentiation, which can occur even in case of tumor recurrence [5].…”

Section: Introductionmentioning

confidence: 99%

“…From a histological point of view, follicular cells within the thyroid gland are responsible for tumorigenesis and generate three main types of differentiated thyroid cancer (DTC): papillary (PTC), follicular (FTC) and mixed cell variants, which account for approximately 95% of all thyroid carcinoma, all of which are commonly well differentiated therefore these tumors are iodine avid and diagnosed/treated with I-123 or I-131, although they also include many subtypes that have different outcomes in terms of response to therapy and prognosis [5]. Undifferentiated and anaplastic tumors are not always iodine avid due to tumor dedifferentiation, which can occur even in case of tumor recurrence [5]. When thyroid neoplastic lesions lose the ability to synthesize hormones from iodine, they show increased glucose metabolism; therefore, patients will have high human thyroglobulin levels and negative I-131 scans.…”

Section: Introductionmentioning

confidence: 99%

PET/CT in thyroid cancer — the importance of BRAF mutations

2020

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Thyroid cancer (TC) represents less than 1% of all newly diagnosed malignancies. In some selected cases, with a high clinical suspicion for disease but negative I-131 scan, positron emission tomography/computed tomography (PET) with F-18-Fluorodeoxyglucose (FDG) could be helpful in the detection of disease and the definition of its extent. FDG PET/CT, better if performed after TSH stimulation analogously to patient preparation done for radioiodine scintigraphy, could be useful mainly in the detection of metastatic and recurrent disease since the uptake and diagnostic sensitivity of FDG are increased by TSH stimulation.Recently, the role of oncogenic mutations in the tumorigenesis of TCs has become clearer. Among such mutations, BRAF V600E represents the most common genetic alteration. Mutated BRAF may define a more aggressive papillary carcinoma with poorer prognosis and therefore its analysis has been extensively studied as a rule-in test for thyroid carcinoma.In this paper, we try to outline the possible role of FDG PET/CT in the management of patients with TC and positive BRAF mutations and the impact that it could have on their therapeutic algorithm, in terms of thyroidectomy and radioactive iodine (RAI) therapy.

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Investigation of thyroid nodules: A practical algorithm and review of guidelines

Abstract: Evidence-based guidelines are available such that a cost-effective algorithm for thyroid nodule workup can be devised. Conservative management with a focus on periodic monitoring is the working clinical consensus on the approach to thyroid nodules.

Cited by 8 publications

References 50 publications

Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

Incidence and malignancy rates classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) – An 8-year tertiary center experience in Thailand

PET/CT in thyroid cancer — the importance of BRAF mutations

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